Health systems need efficient living and working systems and high qualified physicians.

 

Dear Editor, the revitalization of primary health care through the Alma-ata’s WHO/UNICEF Declaration spirit is alarming,[1] because in 1978, USSR still Stalinist socialism was promissory.

 

Since 1760 England and 20 countries increasing quickly liberties, wisdom, technologies, economic growth; producing plentiful food, hygiene and wealth; could reduce progressively terror, oppression, ignorance, hunger, extreme-poverty, epidemics, improving health. Poorest nations can use this ‘know-how’ to develop stable institutions, leading to deep cultural changes, adopting hard-work, rationality and education,[2] to reach all Millennium Development-Goals with self-sustainable growth.

 

Iceland, Australia, Canada, New Zealand and US former colonies deserve study. But more retarded Hong Kong, Singapore, Taiwan, South Korea, Cyprus, and Cuba in its successful period 1804-1958, are the best study-cases.[3-4] They show that comprehensive health care, levels and equality are inseparable part of balanced-progressive living and working care (LWC), levels and equality.

 

Stalinist-socialism has caused LWC/healthcare setback since 1959 in Cuba, employing six-times more physicians of any quality than the amount of high-quality required, focusing short-term infant-pregnant LWC/healthcare, but abandoning longest-term LWC/elder-adult healthcare, due to a 1957-2006 growth of GDP per-person of 1.1-fold (table), while Hong Kong increased it ten-fold.[3-4]

 

WHO Declaration replied to the socialist health-mirage fabricated with abundant Soviet ‘feldshers’, Chinese ‘barefoot’, and Cuban ‘indigent’ physicians (<US$25.oo GP monthly-wage). The world is not demanding four-million physicians more of any quality to preserve this Stalinist approach. It needs high-quality traditional-practitioners, midwives, pharmacists, nurses and GPs to face the scientific challenges of the accelerated-overall update in poorest rural-villages and slums. Special study deserve the experiences of the Sachs-Ehrlich-Sanchez’s Millennium Village Projects in Sub-Saharan Africa, its clinical-economics approach within a bioeconomic-psychosocial paradigm.[5]

 

The scientific research preparation of physicians, mainly GPs, could be re-focused in discovery, invention-innovation of new knowledge-methods. Deepening in the clinical research creative phases of substantial contributions --instead of in routine confirmation designs and analysis--, and strengthening its logic and method will solve the body-mind clinical problem, and integrate the polarized western modern medicine and traditional medicine --specially the Hindu and Chinese.

 

A UNDP/WHO/UNESCO Declaration could be written according to democratic market-economy gold-standards to increase the global living, working and health integrated care, levels and equality.

 

Thank you.

 

Competing Interests: None

 

References:

1. The Lancet. Editorial. Margaret Chan puts primary health care centre stage at WHO. Lancet 2008;371:1811. http://www.thelancet.com/journals/lancet/article/PIIS0140673608607710/fulltext

2. Clark G. A Farewell to Alms: A Brief Economic History of the World. 1st edn. Princeton: Princeton University Press, 2007:.

3. McGuire JW, Frankel LM. Dimensions and determinants of mortality decline in pre-revolutionary Cuba. Harvard Center for Population and Development Studies, Working Paper Series. vol. 14 no. 6. Cambridge, MA, 2004. http://www.globalhealth.harvard.edu/hcpds/wpweb/McGuire_wp1406.pdf  

4. Anon. Correspondence. Cuba's delayed transition needs. Lancet 2006 368(9544):1323. (Oct 14) http://www.thelancet.com/journals/lancet/article/PIIS0140673606695445/fulltext     

5. Sachs JD. The End of Poverty. Economic Possibilities for Our Time, 1st edn, New York: The Penguin Press, 2005:.

 

Table

 

Cuba: Free market-economy 1800-1990-1958 vs. socialism 1959-2008

 

Variable / Year	1800	1900	1957	2006
Infant mortality (<1 year) rate**	300	200	32	5
Life expectancy at birth (years)	28	32	64	77
Gross birth rate	47	32	27	11
Total number of physicians  (physicians working in Cuba)	200	1250	6000	72000* (36000)
Urban population percent (urban infrastructure destroyed)	15	30	54	75* (67)
GDP per-person [1990-GKUS$] (GDP by World Bank norms)	700	1700	2406	3381* (2700)
Total population (million) (emigrants --some eaten by sharks)	0.4	1.6	6.4	11.3* (2)
Access to best LWC/healthcare  elder/adult population percent	1	10	25	1

 

*Indexes adjustments by world standards & specific situations.

**Infant mortality in 1957, only 14^th world lowest rate; in 2006,

28^th-37^th world lowest rate shared with nine countries.

Sources:

-Maddison A. Contours of the World Economy 1-2030 AD. Essays in Macro-Economic History. Oxford University Press, 2007:.

-UNICEF. The State of the World’s Children 2008. New York, NY: UNICEF Database; 2008:.